Pediatric Head to Toe Assessment

1. Barb Gray, RN, MN Easter Seals Ontario Pediatric Head to Toe Assessment Barb Gray, RN, MN Easter Seals Ontario

2. 2018 OCA Accreditation Standards (Day & Overnight Camps)

3. Important differences between children and adults

4. Children are not just little adults. Photographs marked with a star come from Google Images.

5. Some of the differences, include: • A child’s head is larger in proportion to their body than an adult’s head. • Children have smaller airways with more soft tissue and a narrowing at the cricoid cartilage. • A child’s trachea opening and the esophagus opening are closer together than in an adult.

6. The respiratory rate of a child is faster than that of an adult. • Children have faster heart rates • Children have less blood than adults. This makes children at greater risk than adults from bleeding to death or developing severe shock from a relatively minor wound.

7. A child has less muscle and fat mass than an adult. Therefore, a child has less padding and is more vulnerable to blunt trauma than an adult. • Children have more skin surface area in relation to body weight than an adult. This fact means that a child loses more fluid and are therefore more susceptible to dehydration.

8. A child’s abdominal organs are relatively larger than an adult’s. A child’s diaphragm is lower than adults. A child, therefore, is more likely to suffer injuries to the liver, spleen, and duodenum. • A child’s bones are softer and the energy of impact might cause the bones to crack, rather, then break (Green Stick Fracture). • A child’s growth plates are still open and active. Reference http://brooksidepress.org/ob-ped/lessons/lesson-3-pediatric-emergencies/section-i-differences-between-a-childs-body-and-an-adults-body/3-02-differences-between-children-and-adults/

9. When are assessment done at Camp?

10. When a camper is seen in the Health Centre for an: • Injury • Illness • Emotional concern

11. On Arrival Day The head to toe assessment allows the health care providers with an understanding of the overall health of the camper.

12. Getting ready…. • Gather as much data as possible by observation first. • Stay at the child’s level as much as possible. Do not tower!! • Order of exam - from the least distressing to most distressing. .

13. Develop a rapport with the camper • Be sure to communicate clearly with the camper throughout the assessment. • Ask the camper about how they are feeling. They are the expert on their own body. • Always ask before you start touching the camper, and explain what you are doing as you do it.

14. Examine a painful area last. • Be honest. If something is going to hurt, tell the camper in a calm fashion. • Understand how the camper’s developmental stage will impact on their response..

15. Piaget's Theory of Cognitive Development.  Concrete: "You said I'd get it if I missed my asthma inhalers, but I forgot them twice and I stayed fine so I don't need them anymore“ Abstract: "I missed my inhalers a couple of times but I think I got away with it because I wasn't doing much exercise. I think I'll still need them in the future if I'm doing lots of exercise or in cold weather" https://www.rch.org.au/studentorientation/Differences_between_children_and_adults/

16. Documentation is Important! • Remember that documenting the assessment is a critical part of the process. • Many camps have developed checklists or forms that are to be used when completing the assessment.

17. Physical Assessment Forms

18. Red Flags in Pediatric Assessment * Respiratory rate greater than 60 * Nasal flaring * Respiratory distress or failure * Cyanosis * Uncorrected noisy respiration * Significant trauma * Significant hemorrhage * Alterations in consciousness * Pallor * Mottling * Heart rate greater than 180 * Heart rate less than 60 * Seizures * Fever or history of fever with a global rash

19. The most important thing is your first impression.

20. Pediatric Assessment Triangle (PAT)

21. The Physical Assessment

23. Temperature Temperature: Tympanic vs. oral vs. axillary vs. rectal Normal Temperature Range by method. Reference: PedsCases: http://www.pedscases.com/pediatric-vital-signs-reference-chart Temperature Measurement in Pediatrics, 2015

24. Heart Rate & Respiratory Rate • Should be taken for one full minute. Infants and young children should have their heart rate taken at the apex of the heart using a stethoscope. Campers who are older may have a radial pulse taken. Reference: PedsCases: http://www.pedscases.com/pediatric-vital-signs-reference-chart PALS Guidelines, 2015

25. Normal Blood Pressure by Age Appropriate size cuff - 2/3 width of upper arm Reference: PedsCases: http://www.pedscases.com/pediatric-vital-signs-reference-chart PALS Guidelines, 2015

26. The Head

27. Eyes

28. Throat

29. Teeth

30. Heart & Lungs

32. Skin • Acne • Athletes foot (tineapedis) • Scrapes and cuts • Open sores

33. Bruising

34. Signs of Infection: Rashes

35. Mental Health • The camper assessment should also include an assessment of the campers mental, emotional, social health (MESH). • The Centers for Disease Control (CDC, 2015), “it is estimated that 13–20 percent of children (up to one out of five children) living in the United States experience a mental disorder in a given year . . .”

36. Questions?